title: Diagnostic dilemma in sicklers with acute bone crisis: role of subperiosteal fluid collection on MRI in resolving this issue.
abstract: OBJECTIVE
  To establish MRI criteria to diagnose early osteomyelitis in sickle cell disease patients with acute bone crisis and to differentiate it from normally occurring ischaemic changes in these patients.
  
  
  METHODS
  MRI study with and without Gadolinium contrast was carried out in 59 sickle cell disease patients who presented with acute bone crisis from August 2007 to July 2008, and had clinical suspicion of osteomyelitis. We studied the ability of MRI especially the presence of subperiosteal fluid, for the early diagnosis of osteomyelitis and its differentiation from ischaemic changes in these patients.
  
  
  RESULTS
  Depending on MRI diagnostic criteria, we diagnosed 32 cases for osteomyelitis. In 26 patients diagnosis was confirmed microbiologically while 6 patients were treated on clinico radiological basis which showed marked improvement on follow up. Five patients with osteomyelitis had established MR features of osteomyelitis while in 27 cases the diagnosis was made on the basis of presence of subperiosteal fluid.
  
  
  CONCLUSIONS
  Early osteomyelitis is a challenging diagnosis clinically and radiologically in patients with sickle cell disease, which can be diagnosed on M.R.I if special emphasis is put on subperiosteal fluid collection.
authors.affiliation: Medical Imaging Department, King Abdul Aziz Hospital, National Guard Health Affairs, Saudi Arabia.
authors.forename: Sarfraz
authors.initials: S
authors.lastname: Ahmad
authors.forename: Zahid Anwar
authors.initials: ZA
authors.lastname: Khan
authors.forename: Rifat
authors.initials: R
authors.lastname: Rehmani
authors.forename: Muhammad Younus
authors.initials: MY
authors.lastname: Sheikh
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000755:Anemia, Sickle Cell / Q000150:complications*; D001826:Body Fluids; D001842:Bone and Bones; D002648:Child; D002675:Child, Preschool; D003287:Contrast Media; D003937:Diagnosis, Differential; D042241:Early Diagnosis; D005260:Female; D005682:Gadolinium; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D010019:Osteomyelitis / Q000209:etiology / Q000382:microbiology / Q000473:pathology*; D055815:Young Adult
chemical_list: D003287:Contrast Media; D005682:Gadolinium